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腹腔镜远端胃癌根治术手术技巧浅析（附40例报告） 南京医科大学第二附属医院普外科 雷亿群 汪宝林 杨其鹏 董小刚 张建平* 南京市 座机电话号码 [摘要] 目的 探讨腹腔镜远端胃癌根治术的手术技巧。方法 回顾分析2008年1月-2009年3月腹腔镜远端胃癌根治术40例的临床资料，探讨相关手术技巧。结果39例均遵循远端胃癌根治术的一般原则和腔镜操作规范及程序，运用腔镜手术技巧，顺利完成手术。1例中转开腹。平均手术用时300±45分钟，平均出血量130±62ml，清扫淋巴结20.4±8枚，术后排气时间2-4天，术后进流质时间4-6天，下床活动时间2-5天，无近期手术并发症。结论 掌握腔镜下的解剖特点，熟悉腔镜手术操作技巧，有利于规范、顺利完成远端胃癌D2根治术，降低手术风险。 关键词 腹腔镜；胃癌根治术；手术技巧 Aanlysis of operating skills for laparoscopic radical distal gastrictomy attaching a report of 40 cases lei Yiqun , Wang Baolin , Yang Qipeng , Dong Xiaogang , Zhang Jianping . Department of General Surgery, Second Affiliated hospital of Nanjing Medical University , Nangjing 210011,China 【Abstract 】 Objective To investigate the operating skills of laparoscopic radical distal gastrictomy of gastric cancer. Methods The clinical data of 40 gastric cancer patients received laparoscopic radical distal gastrictomy from January 2008 to March 2009 were analyzed retrospectively to investigate the operating skills . Results 39 patients underwent laparoscopic radical distal gastrictomy smoothly by followed the general principle of radical distal gastrictomy in open surgery and laparoscopic operating rules. one patient was conversed to open surgery. The mean operating time was 300?5 minutes. The mean volume of blood loss was 130?2 ml. The numbers of harvested lymph nodes was 20.4?. After surgery, the time of first flatus was 2-4 days,and the time of liquid diet was 4-6 days.and the time for moving at the bed was 2-5 days. No patient occurred postoperative complications. Conclusions It is beneficial for accomplishing standard laparoscopic radical distal gastrictomy smoothly to master the laparoscopic dissect characteristics and the laparoscopic operating skills. 【Key Words】 Laparoscope; Radical resection; Operating skills 自1993年Azagra等[1]完成首例胃癌腹腔镜手术以来，胃癌微创手术以其创伤小、恢复快、对免疫功能影响小、美观等优势逐步获得认可。但由于胃癌腹腔镜手术操作技术要求高，加上腔镜下二维视觉的限制及缺乏开腹手术的手感，其应用仍较局限。本文回顾分析我院近一年来开展的腹腔镜远端胃癌D2根治术40例，初步探讨手术中的一些技巧，报道如下。 1临床资料与方法 1．1 一般资料 本组40例，